We carried out an unannounced comprehensive inspection on 27 October 2018.

The Holt Residential Home provides care and accommodation for up to two people. On the day of our inspection there were two people living at the service. The home provides residential care for people with a learning disability.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post, however they were currently not available. In their absence, there was an acting manager working in the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

At the last inspection on the 17 March 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good:

People were not all able to fully verbalise their views therefore they were not able to tell us verbally about their experience of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. However, one person when asked if they were happy living in The Holt said ‘Yes’ they were.

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the Disclosure and Barring Service (DBS) ensured they were suitable to work with vulnerable adults. There were sufficient numbers of staff to meet people’s needs and help to keep them safe.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and competency checks to test their knowledge and to help ensure their skills in relation to medicines were up to date and in line with best practice.

People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staff practice, and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the equality and diversity and the human right needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported thi

The inspection took place on 17 March 2016 and was unannounced. The home had registered with the Care Quality Commission in February 2015. This was the first inspection of the service following its registration.

The Holt provides accommodation with personal care for up to two people with learning and physical disabilities. Two people lived at the service when we visited. One had started living at the home in early 2015, having moved from another home run by the provider. The other person had only been with the service for four months.

The home is a house located on the outskirts of Exminster; a small village located close to the city of Exeter in Devon. The home had been adapted from a family home and includes two one-bedroomed units, which provided self-contained accommodation for each person living in the home, including separate bedrooms, bathrooms, sitting and dining areas. Between the two units was an office area which staff used during the day and night, when not with the people living at the home.

The home has a manager, who had been registered with the Care Quality Commission since 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were treated with dignity and respect and their preferences were taken into account when delivering their care. Staff respected people’s choices and acted in accordance with each person’s wishes and preferences. - Staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, relatives as well as health and social care professionals were consulted and involved in decision making about people in their 'best interest’.

Detailed risk assessments were in place for each person with actions identified to reduce risks as much as possible. People received their medicines safely and on time.

Staff supported people to become more independent and develop their skills. This included increasing people’s ability to undertake personal care tasks, household skills as well as interpersonal and social skills.

Staff had a good knowledge of people’s communication, care and health needs. Staff received training when they started working at The Holt. There were regular updates of training considered to be mandatory for staff. Staff were also provided training in specialist areas including epilepsy, autism, Asperger’s Syndrome and positive behaviour management. Staff received regular supervision and an annual appraisal. Staff were supported to develop their skills through undertaking nationally recognised qualifications in care.

People’s care records were held on a computerised system. The records provided detailed information about how to support each person. Care plans had been developed with the person, and those close to them. Staff used different communication methods to ensure people were able to be involved.

Staff encouraged people to eat a well-balanced diet and make healthy eating choices which had helped them to lose weight. People were also supported to do exercise which had increased their well-being. Staff worked with healthcare professionals including the person’s GP, specialist medical staff and members of the local learning disability team. Health and social care professionals paid compliments to the home about the care provided.

Staff had completed safeguarding training and knew how to recognise signs of potential abuse. Staff knew how to report any concerns they had.

The provider had a written complaints policy and procedure. One complaint had been received in the last year; this had been investigated and responded to appropriately. . Relatives said they would speak to the r